DeBofsky
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Significant
decisions in ERISA litigation
The single most
significant recent decision in this area may be Regula v. Delta
Family-Care Disability Survivorship Plan.1 In it, the Ninth Circuit
resolved at least three crucial issues.
First,
the court incorporated from Social Security disability claims the
treating-doctor rule, which gives deference to the physicians who
treated the claimant. Second, because the plaintiff had been receiving
benefits for several years, the court questioned the insurer's motivation
to suddenly terminate benefits based on thin evidence. Third, the
court was highly suspicious of the reviewing and ex amining doctors'
being frequently called upon by insurers. This ruling will favor plaintiffs
in future cases by giving more weight to treating doctors' opinions
and causing a disregard for reviewers and examiners known to frequently
side with the insurer. The ruling also makes it much more difficult
to terminate disability-benefit payments after the initial approval.
Two
other decisions of note, Lasser v. Reliance Standard Life Insurance
Co.2 and Saliamonas v. CNA, Inc.,3 deal with the recurrent
issue of risk of disability. Those district courts ruled that claimants
need not die in order to collect benefits; a significant risk of further
aggravating their impairments was sufficient to require benefit payments.
Cases
involving diseases such as fibromyalgia and chronic fatigue syndrome
are often difficult. Dorsey v. Provident Life and Accident Insurance
Co.4 and Brenner v. Hartford Life & Accident Insurance Co.5
were solid victories for plaintiffs. Although the plaintiffs lacked
clear-cut, objective evidence, the district courts held that claimants
are entitled to benefits even in the face of surveillance and reviewing-doctors'
opinions recommending denial of benefits.
In
Ebert v. Reliance Standard Life Insurance Co., a federal district
court in Ohio rejected the notion that a disability insurer does not
have to consider the specific demands of a plaintiff's job.6 The court
also criticized the insurer for its selective review of evidence.
The
Second Circuit ruled in Dunnigan v. Metropolitan Life Insurance
that prejudgment interest is required on over due disability benefit
payments.7
Notes
1. 266
F.3d 1130 (9th Cir. 2001).
2. 146
F. Supp. 2d 619 (D.N.J. 2001).
3. 127
F. Supp. 2d 997 (N.D. Ill. 2001).
4. 167
F. Supp. 2d 846 (E.D. Pa. 2001).
5. 2001
WL 224826 (D. Md. Feb. 23, 2001).
6. 171
F. Supp. 2d 726 (S.D. Ohio 2001).
7. 277
F.3d 223 (2d Cir. 2002).
—Mark
D. DeBofsky
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